Dependents age 19-26 and GIC benefits

As part of federal health care reform, coverage for dependent children was extended to the age of 26. Family coverage is required to add your dependent to health and/or GIC Dental/Vision coverage.

Eligibility

Eligible dependents under federal health care reform

The definition of a dependent under federal health care reform is a son, daughter, stepson, stepdaughter, adopted child, or eligible foster child. To be eligible for coverage as a foster child, the child must be placed by an authorized placement agency or by judgment, decree, or other order of any court of competent jurisdiction.

IF your dependent does meet the definition as described above, your dependent may be eligible for health coverage under Massachusetts health care reform. Contact the GIC at [phone] for the Massachusetts Health Care Reform Dependent Age 19 to 26 form.

Eligible full-time students

To be eligible for coverage as a full-time student, the dependent must attend an accredited college or university, vocational or secondary school on a full-time basis.

If your full-time student goes to school outside of our health plan's network you may remain in your current health plan

Your family may remain in your current health plan for as long as your child is a full-time student. Contact your health plan for full-time student coverage information. If your child age 19 – 26 ceases to be a full-time student, complete and return the Dependent Age 19 to 26 Enrollment/Change Form to notify the GIC of the change. Non-student adult children age 19 – 26 may reside outside of your plan’s service area but will be subject to the plan’s coverage rules. Be sure to review your plan’s out of service area coverage and consider whether you should change to a plan providing greater geographical coverage for your dependent. Requests for health plan changes are made on a prospective basis; retroactive coverage changes are not allowed.

All full-time students have urgent and emergency care coverage. Some GIC health plans require students to receive routine care when they return home to the service area. Other GIC plans offer out-of-area network providers where full-time students can receive routine care. Check with the individual plans for additional details.

Your student dependent is also covered during the summer only if he/she was enrolled as a full-time student for the entire spring semester and is enrolled as full-time student for the following fall semester. If your dependent is not returning to school in the fall, complete the Dependent Age 19 to 26 form to continue the dependent's coverage under federal health care reform.

If your child age 19 – 26 ceases to be a full-time student, complete and return the Dependent Age 19 to 26 Enrollment/Change Form to notify the GIC of the change. Your dependent will continue to be eligible for coverage up to the last day of the month your dependent turns age 26, as long as, you the insured, have GIC family coverage.

For non-students age 19 to 26 living outside of your health plan's service area

If your dependent age 19-26 lives outside the health plan’s service are you should review the plan’s out of service area coverage and consider whether you should change to a plan providing greater geographical coverage for your dependent. Requests for health plan changes are made on a prospective basis; retroactive coverage changes are not allowed. Keep in mind that under many plans most out of network medical care is either not covered or covered at a reduced level requiring greater out of pocket costs to you.

Enrollment

How to enroll your child between the ages of 19-26 in GIC health and dental coverage

If your child is between age 19 and 26 and is not currently enrolled in GIC coverage, apply for coverage by completing and returning to the GIC the Dependent Age 19 to 26 Enrollment Change Form.  Requirements are found on the form.

If you have not previously submitted the following documentation, it must accompany the Dependent Age 19 to 26 Enrollment and Change Form:

• Children/stepchildren: photocopy of birth certificate showing parent-child relationship of insured or insured's spouse
• Adopted children: photocopy of proof of placement letter or adoption
• Foster child: photocopy of proof of placement letter or court order

Removing a dependent

If your dependent has a qualifying event, you may remove them from your GIC coverage.  You must complete the Enrollment/Change form and attach proof of the qualifying event. The GIC must receive the form and documentation within 60 days of the qualifying event.  Otherwise, you must wait until Annual Enrollment to remove the dependent. 

Things you should know

For covered dependents age 19-26 that are getting married, and the effect on their GIC health insurance coverage

Most dependents age 19 to 26 are covered under the insured’s family health plan.  The Affordable Care Act allows coverage for your dependent up to age 26, whether or not they are married.  If your dependent age 19 to 26 is coverage under another status, such as full-time student, contact the GIC at [phone] for your dependent’s coverage options.

Dependents turning age 26 health insurance options

If your dependent is turning age 26 and is a Massachusetts resident, he/she may purchase health insurance from the Health Connector(1.877.623.6765).  If he/she lives out of state, contact the Health Insurance Marketplace for coverage information in that state. Alternately, he/she may elect GIC COBRA coverage.

How to cover disabled children ages 19-26

Please note that in order for a dependent to apply for handicapped dependent coverage, he or she must meet one of the following conditions:

• became mentally or physically incapable of earning his/her own living prior to age 19; or
• became permanently and totally disabled and became so on or after age 19 and is under age 26.
• These dependents will only be covered until the last day of the month they turn 26.

If your dependent meets one of thee conditions, you must complete a Handicapped Dependent Application and return it to the GIC.